Ali Parsa, MD; Saeid Esmaeilian, MD, MPH; Adam W. Anz, MD; Farimah Naghibian, MD; Morteza
Behjat, MD; Neda Mirzaei, PhD; Elham Rahmanipour, MD, MPH; Mohammad Ghorbani, MD, MPH
———-
Research performed at Mashhad University of Medical Sciences, Mashhad, Iran
Received: 18 September 2024 Accepted: 20 November 2024
Abstract
Objectives: This scoping review aims to evaluate the safety and efficacy of orthobiologics in the
treatment of Greater Trochanteric Pain Syndrome (GTPS), with a focus on pain relief, functional
improvement, and quality of life.
Methods:
We conducted a comprehensive search of PubMed, Embase, Cochrane Library, Web of Science, Scopus,
Google Scholar, and CINAHL for studies published from January 1, 2000, to March 20, 2024. Eligible studies
included case series, cohort studies, case-control studies, and randomized controlled trials (RCTs) that investigated
the use of orthobiologics for GTPS. The primary outcomes assessed were pain, function, and quality of life. The
quality of the studies was evaluated using the JADAD scale, the Cochrane Risk of Bias Tool, and the MINORS
score.
Results:
The review included 19 studies involving a total of 811 participants. Platelet-rich plasma (PRP) was found
to significantly reduce pain, as measured by the VAS scores, and to improve functional outcomes including the
modified Harris Hip Score (mHHS) and the Western Ontario and McMaster Universities Osteoarthritis Index
(WOMAC) scores. These findings suggest that PRP may be an effective treatment for GTPS. The studies reported
minimal side effects that were generally mild and transient.
Conclusion:
PRP and other orthobiologic treatments show promise in managing GTPS, showing good safety
profiles and potential benefits. However, further high-quality RCTs are necessary to confirm long-term efficacy and
to establish standardized treatment protocols.
Level of evidence: II
Keywords:
Autologous tenocyte injection, Bone marrow aspirate concentrate, Corticosteroid injection, Greater
trochanteric pain syndrome, Hyaluronic acid, Orthobiologics, Platelet-rich plasma, Scoping Review
Abstract
Objectives: This scoping review aims to evaluate the safety and efficacy of orthobiologics in the
Introduction
Greater Trochanteric Pain Syndrome (GTPS) is a musculoskeletal condition characterized by pain in the lateral hip area. 1 It commonly affects older adults, particularly middle-aged women,2,3 with approximately 1 in 4 women over the age of 50 experiencing this condition.4 Annually, GTPS impacts around 1.8 per 1,000 individuals5 and is most prevalent during the fifth and sixth decades of life.4 GTPS includes conditions such as trochanteric bursitis, gluteal tendinopathy, and coxa saltans.6,7 These associated disorders can exhibit varying clinical features, which contribute to the complexity of diagnosis and treatment. Additionally, GTPS is often linked with other musculoskeletal conditions, such as osteoarthritis and lower back pain,6 which further complicate its management and may adversely affect treatment outcomes.1,4 Management of GTPS typically begins with conservative treatments including nonsteroidal anti-inflammatory drugs (NSAIDs), weight management, and targeted strengthening exercises for the gluteal muscles.8,9 When these measures fail to provide adequate relief, more intensive treatments, such as corticosteroid injections (CSI) or, in severe cases, surgical interventions may be necessary. Injections, including corticosteroids or orthobiologic options, are generally considered when patients continue to experience significant pain and restricted movement after attempting conservative treatments, which may include NSAIDs, physical therapy, and lifestyle modifications.10,11 They are typically recommended when pain persists and interferes with daily activities, and initial non-surgical approaches do not yield sufficient relief.8 While corticosteroids can offer short-term pain relief, their long-term effectiveness is limited, underscoring the need for alternative and more sustainable treatment options.12 Orthobiologics, derived from sources such as bone marrow and blood, are being studied for their potential
effects on musculoskeletal repair.10,13 These substances
contain cytokines and growth factors that, when injected,
target the treatment area to support healing, reduce
inflammation, and repair tendons, bones, ligaments, and
muscles.14-17 Common orthobiologics include platelet-rich
plasma (PRP),18 bone marrow aspirate concentrate
(BMAC),18,19 bone morphogenetic proteins,10,16
mesenchymal stem cells,10 hyaluronic acid (HA),20
autologous tenocyte injection (ATI),21 and amniotic
membrane.10 PRP and BMAC have gained the most
attention for their role in promoting tissue healing and
reducing inflammation.18,22 while HA and ATI have also
shown promising results.20,21 Orthobiologics are also used
in hand surgery, foot and ankle fusion, and hip disorders to
promote bone healing and joint stability.14,17,23
Despite the potential benefits of orthobiologics,
significant challenges persist, including variability in
preparation, administration, and clinical outcomes. These
factors complicates the establishment of standardized
treatment protocols. Existing studies on these treatments
often vary in methodology and quality, relying on small
sample sizes or retrospective data. This variability
complicates comprehensive assessments of their
effectiveness and cost-efficiency.4,10,14,15
This scoping review focuses on chronic GTPS and aims
to provide an overview of the current evidence regarding
the safety and efficacy of orthobiologic treatments.
Additionally, this review will identify gaps in the existing
research, emphasizing areas where further studies are
needed to optimize the use of these promising therapies.
Materials and Methods
Search Strategy
Search databases including PubMed, Embase, Cochrane
Library, Web of Science, Scopus, Google Scholar, and CINAHL
were searched using PRISMA principles. Using a
combination of terms associated with GTPS and
orthobiologics therapies, the search covered the period from
January 1st, 2000 to March 20th, 2024. The search terms
were modified to fit the particular indexing system of each
database. The objective was to document how orthobiologic
therapy improved over a 20-year period. A comprehensive
strategy for each database is detailed in Appendix A. Using a
